Active NPI
Michael Jon Benoit, MD
- Family Medicine Physician
- Bremerton, WA
National Provider Identifier
1972606135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD00017979
- Practice address
- 2528 Wheaton Way
Suite 105
Bremerton, WA 98310-3305 - Phone
- (360) 373-0303
- NPI assigned
- Sep 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD00017979 | WA | Primary |
Addresses
Primary practice location
2528 Wheaton Way
Suite 105
Bremerton, WA 98310-3305
Mailing address
2528 Wheaton Way
Suite 105
Bremerton, WA 98310-3305
Phone (360) 373-0303
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17005 | Other | WA | L & I |
| 162223100000 | Other | PREMERA | |
| BE5062 | Other | WA | REGENCE |
| 1343607 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197590400000",
"number": "1972606135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2528 WHEATON WAY",
"address_2": "SUITE 105",
"city": "BREMERTON",
"state": "WA",
"postal_code": "983103305",
"telephone_number": "360-373-0303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2528 WHEATON WAY",
"address_2": "SUITE 105",
"city": "BREMERTON",
"state": "WA",
"postal_code": "983103305",
"telephone_number": "360-373-0303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENOIT",
"first_name": "MICHAEL",
"middle_name": "JON",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-06",
"last_updated": "2007-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "MD00017979",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L & I",
"identifier": "17005",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREMERA",
"identifier": "162223100000",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE",
"identifier": "BE5062",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1343607",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bremerton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.